Unrelated donor allogeneic transplantation after failure of autologous transplantation for acute myelogenous leukemia: a study from the center for international blood and marrow transplantation research

James M Foran, Steven Z Pavletic, Brent R Logan, Manza A Agovi-Johnson, Waleska S Pérez, Brian J Bolwell, Martin Bornhäuser, Christopher N Bredeson, Mitchell S Cairo, Bruce M Camitta, Edward A Copelan, Jason Dehn, Robert P Gale, Biju George, Vikas Gupta, Gregory A Hale, Hillard M Lazarus, Mark R Litzow, Dipnarine Maharaj, David I Marks, Rodrigo Martino, Richard T Maziarz, Jacob M Rowe, Philip A Rowlings, Bipin N Savani, Mary Lynn Savoie, Jeffrey Szer, Edmund K Waller, Peter H Wiernik, Daniel J Weisdorf, James M Foran, Steven Z Pavletic, Brent R Logan, Manza A Agovi-Johnson, Waleska S Pérez, Brian J Bolwell, Martin Bornhäuser, Christopher N Bredeson, Mitchell S Cairo, Bruce M Camitta, Edward A Copelan, Jason Dehn, Robert P Gale, Biju George, Vikas Gupta, Gregory A Hale, Hillard M Lazarus, Mark R Litzow, Dipnarine Maharaj, David I Marks, Rodrigo Martino, Richard T Maziarz, Jacob M Rowe, Philip A Rowlings, Bipin N Savani, Mary Lynn Savoie, Jeffrey Szer, Edmund K Waller, Peter H Wiernik, Daniel J Weisdorf

Abstract

The survival of patients with relapsed acute myelogenous leukemia (AML) after autologous hematopoietic stem cell transplantation (auto-HCT) is very poor. We studied the outcomes of 302 patients who underwent secondary allogeneic hematopoietic cell transplantation (allo-HCT) from an unrelated donor (URD) using either myeloablative (n = 242) or reduced-intensity conditioning (RIC; n = 60) regimens reported to the Center for International Blood and Marrow Transplantation Research. After a median follow-up of 58 months (range, 2 to 160 months), the probability of treatment-related mortality was 44% (95% confidence interval [CI], 38%-50%) at 1-year. The 5-year incidence of relapse was 32% (95% CI, 27%-38%), and that of overall survival was 22% (95% CI, 18%-27%). Multivariate analysis revealed a significantly better overal survival with RIC regimens (hazard ratio [HR], 0.51; 95% CI, 0.35-0.75; P <.001), with Karnofsky Performance Status score ≥90% (HR, 0.62; 95% CI, 0.47-0.82: P = .001) and in cytomegalovirus-negative recipients (HR, 0.64; 95% CI, 0.44-0.94; P = .022). A longer interval (>18 months) from auto-HCT to URD allo-HCT was associated with significantly lower riak of relapse (HR, 0.19; 95% CI, 0.09-0.38; P <.001) and improved leukemia-free survival (HR, 0.53; 95% CI, 0.34-0.84; P = .006). URD allo-HCT after auto-HCT relapse resulted in 20% long-term leukemia-free survival, with the best results seen in patients with a longer interval to secondary URD transplantation, with a Karnofsky Performance Status score ≥90%, in complete remission, and using an RIC regimen. Further efforts to reduce treatment-related mortaility and relapse are still needed.

Conflict of interest statement

CONFLICTS OF INTEREST: None

Copyright © 2013 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
Cumulative Incidence of Relapse and Treatment-related Mortality
Figure 2
Figure 2
Probability of Overall Survival and Leukemia-Free Survival
Figure 3
Figure 3
Probability of Overall Survival According to 5 Risk Factors at Time of Secondary URD Allo-HCT (Risk Factors:

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